The Mental Health Effects of Torture Trauma and Its Severity: A Replication and Extension


To clarify the effects of torture trauma and its components on PTSD and other mental health conditions, we investigated the relationship between measures for PTSD, Cumulative trauma disorders CTD, cumulative life trauma, torture and torture severity in a sample of 326 torture survivors. Hierarchical multiple regressions found no significant association between torture and PTSD. However, when we examined the effects of different types of torture we found witnessing and sexual tortures were significant predictors of PTSD and CTD. Path analysis results found that torture trauma and its severity may not be predicative of PTSD; but it is highly predictive of the more complex syndromes of CTD. The implications of the results for treating torture survivors were discussed. One of the important findings is the potential effects of torture on decreased re-experiencing and emotional numbness. Torture trauma may be too emotionally and physically painful experience that tends to be suppressed decreasing re-experiencing and increasing dissociation.

Share and Cite:

Kira, I. , Ashby, J. , Odenat, L. & Lewandowsky, L. (2013). The Mental Health Effects of Torture Trauma and Its Severity: A Replication and Extension. Psychology, 4, 472-482. doi: 10.4236/psych.2013.45067.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Arbuckle, J. L. (2006). Amos 7.0 user’s guide. Chicago: SPSS.
[2] Abramson, D. M., Stehling-Ariza, T., Park, Y. S., Walsh, L., & Culp, D. (2010). Measuring individual disaster recovery: A socioecological framework. Disaster Medicine and Public Health Preparedness, 4, 46-54. doi:10.1001/dmp.2010.14
[3] Alexander, J. C. (2004). Toward a theory of cultural trauma. In J. C. Alexander, R. Eyerman, B. Giesen, N. J. Smelser, & P. Sztompka (Eds.), Cultural trauma and collective identity (pp. 1-30). Berkeley: University of California Press. doi:10.1525/california/9780520235946.003.0001
[4] Basoglu, M. (2009). A multivariate contextual analysis of torture and cruel, inhuman, and degrading treatments: Implications for an evidence-based definition of torture. American Journal of Orthopsychiatry, 79, 135-145. doi:10.1037/a0015681
[5] Becker, D., Lira, E., Castillo, M. I., Gómez, E., & Kovalskys, J. (1990). Therapy with victims of political repression in Chile: The challenge of social reparation. Journal of Social Issues, 46, 133-149. doi:10.1111/j.1540-4560.1990.tb01939.x
[6] Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., & Keane, T. M. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. The Behavior Therapist, 13, 187-188.
[7] Courtois, C., Ford, J., Herman, J., & van der Kolk, B. (2009). Treating complex traumatic stress disorders: An evidence-based guide. Guilford: Guilford Press.
[8] Crumlish, N., & O’Rourke, K. (2010). A systematic review of treatments for post-traumatic stress disorder among refugees and asylumseekers. Journal of Nervous and Mental Disorders, 198, 237. doi:10.1097/NMD.0b013e3181d61258
[9] Ford, J., & Russo, E. (2006). Trauma-focused present-centered emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: Trauma adaptive recovery group education and therapy (TARGET). American Journal of Psychotherapy, 60, 335-355.
[10] Gleiser, K., Ford, J., & Fosha, D. (2008). Contrasting exposure and experiential therapies for complex PTSD. Psychotherapy: Theory, Research, Practice, Training, 45, 340-360. doi:10.1037/a0013323
[11] Harvey, M. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9, 3-23. doi:10.1002/jts.2490090103
[12] Herman, J. (1997). Trauma and recovery. New York: Basic Books.
[13] Hollifield, M., Warner, T., & Westermeyer, J. (2011). Is torture reliably assessed and a valid indicator of poor mental health? Journal of Nervous & Mental Disease, 199, 3-10. doi:10.1097/NMD.0b013e3182051501
[14] Hooberman, J., Rosenfeld, B., Lhewa, D., Rasmussen, A., & Keller, A. (2007). Classifying the torture experiences of refugees living in the United States. Journal of Interpersonal Violence, 22, 1-16. doi:10.1177/0886260506294999
[15] Isakson, B. L., &. Jurkovic, G. (2013). Healing after torture: The role of moving on. Qualitative Health Research, 23, 749-761. doi:10.1177/1049732313482048
[16] Johnson, H., & Thompson, A. (2008). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review 2008, 28, 36-47. doi:10.1016/j.cpr.2007.01.017
[17] Kazdin, A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Counseling and Clinical Psychology, 66, 19-36. doi:10.1037/0022-006X.66.1.19
[18] Kira, I. (2001). Taxonomy of trauma and trauma assessment. Traumatology, 2, 1-14.
[19] Kira, I. (2002). Torture assessment and treatment: The wraparound approach. Traumatology, 8, 23-51.
[20] Kira, I. (2010). Etiology and treatments of post-cumulative traumatic stress disorders in different cultures. Traumatology: An International Journal, 16, 128-141.
[21] Kira, I., Templin, T., Lewandowski, L., Ashby, J. S., Oladele, A., & Odenat, L. (2012a). Cumulative trauma disorder scale: Two studies. Psychology, 3, 643-656. doi:10.4236/psych.2012.39099
[22] Kira, I., Ahmed, A., Wassim, F., McAdams-Mahmoud, V., Clorain, J., & Rai, D. (2012b). Group therapy for refugees and torture survivors: Treatment models innovations. International Journal of Group Psychotherapy, 62, 63-83. doi:10.1521/ijgp.2012.62.1.69
[23] Kira, I., Fawzi, M., & Fawzi, M. (2012). The dynamics of cumulative trauma and trauma types in adults patients with psychiatric disorders: Two cross-cultural studies. Traumatology, Advanced online Publication.
[24] Kira, I., Templin, T., Lewandowski, L., Ramaswamy, V., Bulent, O., Abu-Mediane, S., Mohanesh, J., & Alamia, H. (2011). Cumulative Tertiary appraisal of traumatic events across cultures: Two studies. Journal of Loss and Trauma: International Perspectives on Stress & Coping, 16, 43-66. doi:10.1080/15325024.2010.519288
[25] Kira, I., Ahmed, A., Mahmoud, V., & Wassim, F. (2010). Group therapy model for refugee and torture survivors. Torture: An International Journal, 20, 108-113.
[26] Kira, I., Smith, I., Lewandowski, L., & Templin, T. (2010). The effects of perceived gender discrimination on refugee torture survivors: A cross-cultural traumatology perspective. Journal of the American Psychiatric Nurses Association, 16, 299-306. doi:10.1177/1078390310384401
[27] Kira, I., Lewandowsi, L., Templin, T., Ramaswamy, V., Ozkan, B., & Mohanesh, J. (2010). The effects of perceived discrimination and backlash on Iraqi refugees’ physical and mental health. Journal of Muslim Mental Health, 5, 59-81. doi:10.1080/15564901003622110
[28] Kira, I., Lewandowsk, L., Templin, T., Ramaswamy, V., Ozkan, B., & Mohanesh, J. (2008). Measuring cumulative trauma dose, types and profiles using a development-based taxonomy of trauma. Traumatology, 14, 62-87. doi:10.1177/1534765608319324
[29] Kira, I., Hammad, A., Lewandowski, L., Templin, T., Ramswamy, V., Ozkan, B., & Mohanesh, J. (2007). The health and mental status of Iraqi refugees and their etiology. Ethnicity & Disease, 17, 79-82.
[30] Kira, I., Templin, T., Lewandowski, L., Clifford, D., Wiencek, E., Hammad, A., Al-Haidar, A., & Mohanesh, J. (2006). The effects of torture: Two community studies. Peace and Conflict: Journal of Peace Psychology, 12, 205-228. doi:10.1207/s15327949pac1203_1
[31] Kruse, J., Joksimovic, L., Cavka, M., Woller, W., & Schmitz, N. (2010). Effects of trauma-focused psychotherapy upon war refugees. Journal of Traumatic Stress, 22, 585-592.
[32] McColl, H., Higson-Smith, C., Gjerding, S., Omar, M., Rahman, B., Hamed, M., et al. (2010). Rehabilitation of torture survivors in five countries: Common themes and challenges. International Journal of Mental Health Systems, 4, 16. doi:10.1186/1752-4458-4-16
[33] Miller, K. E. (1999). Rethinking a familiar model: Psychotherapy and the mental health of refugees. Journal of Contemporary Psychotherapy, 29, 283-306. doi:10.1023/A:1022926721458
[34] Mollica, R., McInnes, K., Poole, C., & Tor, S. (1998). Dose effect relationship of trauma to symptoms of depression and PTSD among Cambodian survivors of mass violence. British Journal of Psychiatry, 173, 482-488. doi:10.1192/bjp.173.6.482
[35] Neuner, F., Kurreck, S., Ruf, M., Odenwald, M., Elbert, T., & Schauer, M. (2009). Can asylum seekers with posttraumatic stress disorder be successfully treated? A randomized controlled pilot study. Cognitive Behavior Therapy, 34, 1-11.
[36] O’Brien, R. M. (2007). A caution regarding rules of thumb for variance inflation factors. Quality and Quantity, 41, 673-690. doi:10.1007/s11135-006-9018-6
[37] Ortmann, J., Genefke, I., Jakobsen, L., & Lunde, I. (1987). Rehabilitation of torture victims: An interdisciplinary treatment model. American Journal of Social Psychiatry, 7, 161-167.
[38] Pope, K. S. (2001). Torture. In J. Worrell’s (Ed.), Encyclopedia of women and gender: Sex similarities and differences and the impact of society on gender (pp. 1-1256). San Diego, CA: Academic Press.
[39] Punamaki, R., Qouta, S. R., & EI Sarraj, E. (2010). Nature of torture, PTSD, and somatic symptoms among political ex-prisoners. Journal of Traumatic Stress, 23, 532-536. doi:10.1002/jts.20541
[40] Quiroga, J., & Jaranson, J. (2005). Politically-motivated torture and its survivors: A desk study review of the literature. Torture, 15, 1-111.
[41] Rasmussen, A., Rosenfeld, B., Reeves, K., & Keller, A. S. (2007). The effects of torture-related injuries on long-term psychological distress in a Punjabi Sikh sample. Journal of Abnormal Psychology, 116, 734-740. doi:10.1037/0021-843X.116.4.734
[42] Robjant, K., & Fazel, M. (2010). The emerging evidence for narrative exposure therapy: A review. Clinical psychology review, 30, 1030-1039. doi:10.1016/j.cpr.2010.07.004
[43] Schmitt, N. (1996). Uses and abuses of coefficient alpha. Psychological Assessment, 8, 350-353. doi:10.1037/1040-3590.8.4.350
[44] Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Journal of the American Medical Association, 302, 537-549. doi:10.1001/jama.2009.1132
[45] Summerfield, D. (2004). Cross-cultural perspectives on the medicalization of human suffering. In G. M. Rosen (Ed.), Posttraumatic stress disorder: Issues and controversies (pp. 233-245). New York: Wiley. doi:10.1002/9780470713570.ch12
[46] Vorbrüggen, M., & Baer, H. U. (2007). Humiliation: The lasting effect of torture. Military Medicine, 172, S29-S33.
[47] Zerach, G., Greene, T., Ginzburg, K., & Solomon, Z. (2013). The Relations between posttraumatic stress disorder and persistent dissociation among ex-prisoners of war: A longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.